Integrated hipaa-compliant computer security system for permitting an individual&#39;s circle of support to have access to individual budget and service plan data, and to monitor a plan for achieving the individual&#39;s goals

ABSTRACT

Systems and methods are described which permit the state, the individual, the individual&#39;s case manager, and the individual&#39;s circle of support to have real time access to utilization data to monitor services and progress toward outcomes as part of a plan for achieving the individual&#39;s goals and maintain the individual&#39;s health and wellbeing, as well as to forecast future needs. Systems and methods for sharing billing information across at least two organizations in an integrated manner are also described. A physical node may receive a request for authorization for a user in an organization to access an individual&#39;s information in another organization. The request may be logged. The physical node may determine whether the user is authorized to access the individual&#39;s information and, if it is, provide appropriate access.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims benefit of U.S. Provisional Application No.62/186,193, filed Jun. 29, 2015, and is a continuation-in-part of U.S.patent application Ser. No. 13/675,440 filed Nov. 13, 2012 and U.S.patent application Ser. No. 14/332,681 filed Jul. 16, 2014; Thisapplication also claims priority of U.S. Pat. No. 8,281,370, filed Nov.27, 2006; U.S. Pat. No. 8,528,056 filed Sep. 6, 2012; U.S. Pat. No.8,613,054 filed Aug. 31, 2012; U.S. Pat. No. 8,615,790 filed Aug. 31,2012; U.S. Pat. No. 8,739,253 filed May 31, 2013; U.S. Pat. No.8,819,785 filed Nov. 2, 2012 the disclosures and teachings of each ofwhich are incorporated herein by reference in their entirety.

BACKGROUND OF THE DISCLOSURE

Currently, individuals requiring care are assigned a budget based on anassessment of their needs. The individual and their support circle,including family, friends, case managers, guardians, service providers,and others, decides how to spend that budget on a range of servicesprovided by a variety of companies and individuals. This is done inconjunction with developing a plan for how to achieve that person'sgoals and maintain his health and wellbeing. This is traditionally doneusing paper. The budget goes through an approval process, and if needed,an exception process, which is usually for a short term. SeparateService Authorizations are then generated, mailed to the appropriateproviders and entered into the payment system. Once they have providedthe system, providers will bill the payor for those services. Manualaudits are conducted on samples to assure that services are provided andappropriately billed for by the right people/companies. This process iscumbersome and inefficient.

A system that integrates the many aspects of providing care services foran individual would be desirable.

BRIEF SUMMARY OF THE DISCLOSURE

Systems and methods for sharing billing information across at least twoorganizations in an integrated manner are described. A physical node mayreceive a request for authorization for a user in an organization toaccess an individual's information in another organization. The requestmay be logged. The physical node may determine whether the user isauthorized to access the individual's information and, if it is, provideappropriate access. Also disclosed is an integrated web application andsystem which includes the core plan, budget, service authorizations,service documentation, claims, and communications of an individual undercare and allows for calculated access and communication with externalauthorization and payment systems.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is an overview of an exemplary integrated billing and servicesprocess according to the present invention.

FIG. 2 depicts an overview of the unified budget and cost plan of theinvented system.

FIG. 3 depicts a screen shot of an exemplary Individual Budgeting page.

FIG. 4 depicts a screen shot of an exemplary Individual List page.

FIG. 5 depicts a screen shot of a further exemplary Individual Budgetingpage.

FIG. 6 depicts a screen shot of an exemplary Budget page.

FIG. 7 depicts a screen shot of an exemplary Service Authorization page.

FIG. 8 depicts a screen shot of an exemplary Budget Review page.

FIG. 9 depicts a screen shot of an exemplary IBA Exception page.

FIG. 10 depicts a screen shot of an exemplary IBA Exception Review page.

FIG. 11 depicts a screen shot of an exemplary Roles page with IB DataAdmin module role selected.

FIG. 12 depicts a screen shot of an exemplary IB Data Admin Module page.

FIG. 13 depicts a screen shot of an exemplary Billing page.

FIG. 14 depicts a screen shot of an exemplary Service Description/Codepage.

FIG. 15 depicts a screen shot of an exemplary Billing Claim page.

FIG. 16 depicts another screen shot of an exemplary ServiceDescription/Code page.

FIG. 17 depicts a screen shot of an exemplary Attendance Report page.

FIG. 18 depicts a screen shot of an exemplary portion of an AttendanceReport page.

FIG. 19 depicts a screen shot of an exemplary Service Consumption page.

FIG. 20 depicts a screen shot of an exemplary Professional Claim page.

FIG. 21 depicts a screen shot of an exemplary Costs share page.

FIG. 22 depicts a screen shot of an exemplary Submitted Consumed UnitList page.

FIG. 23 depicts a screen shot of an exemplary Billing page with theBilling Provider module selected.

FIG. 24 depicts a screen shot of an exemplary Billing Data page.

FIG. 25 depicts a screen shot of an exemplary Roles page with IBProvider Data Admin module selected.

FIG. 26 depicts a screen shot of an exemplary page to create an IBBilling Document.

FIG. 27 depicts another screen shot of an example of an IB BillingDocument page.

FIG. 28 depicts a screen shot of an exemplary IBA Worksheet.

FIG. 29 depicts a screen shot of an exemplary Billing page showing aSystem Rejected Worklist screen.

FIG. 30 depicts a screen shot of an exemplary Professional Claim page.

FIG. 31 depicts a screen shot of an exemplary non-specialized ServiceProvider List.

FIG. 32 depicts a screen shot of an exemplary non-specialized ServiceProvider page.

FIG. 33 depicts a screen shot of an exemplary Remittance Report in Textformat.

FIG. 34 depicts the functionality of IBA Approve, Budget Create, BudgetReview, Budget Approve, and Budget Special Approve roles.

FIG. 35 is a flowchart showing organizational and communicationshierarchies.

DETAILED DESCRIPTION OF THE DISCLOSURE

The invention relates to an integrated web application which includesthe core plan, budget, service authorizations, service documentation,claims, and communications of an individual under care and allows forcalculated access and communication with external authorization andpayment systems.

In the invented system, the core plan, budget, service authorizations,service documentation, claims, and communication are housed within asystem, such as a single web application, which allows for calculatedaccess and communication with external authorization and payment system(FIGS. 1-2). As outlined in FIG. 1, the process begins with intake andeligibility steps 10 which include assessment of the individual's needs20 and calculation of the Individual Budget Amount 30 (IBA) for theindividual's treatment. Based on the IBA, the individual's team (whichcan be represented by the case manager/service coordinator) develops abudget and cost plan 40 and an Individual Service Plan 50 (ISP) withinthe system.

The total Individual Budget Amount and Individual Service Plan iscalculated based on an assessment of the individual's needs. These plansare available to team members with the application based on roles andcaseloads, as described in U.S. Pat. No. 8,281,370. When the budget isapproved by a supervisor, each service authorization within it is thensent to the provider agency 60 that will be providing the service,selected from a service directory 70. Each agency can not only see itsown authorizations, but can see the whole plan.

If the agency accepts the authorization, the system automatically setsup the appropriate attendance log where direct support staff can enterdata 80 in real time as to when the individual was present and receivingthe authorized service. Data collection 90 includes attendance andbilling data. An agency supervisor can review and approve the attendancedata. Access to this functionality is based on roles and caseloads. Onceapproved, the agency's finance staff can then generate claims 100 with acouple of clicks, as opposed to the long and complicated processinvolving paper and multiple systems. The claims are then routed to theappropriate service coordinator for approval. If approved they are sentto a payor 110 such as the state MMIS (Medicaid and Medicare informationsystem) for payment. If rejected, they are returned to the provider. Thestate, individual, case manager and circle of support can now all havereal time access to utilization data to monitor services and progresstoward outcomes 120, generate utilization reports 130 as needed, andforecast future needs (based on caseloads and super roles).

As outlined in FIG. 2, the unified budget and cost plan 210 begins witha billing setup 220, which includes identification of funding source,service codes, and billing providers. Service authorization 230 is thenext step, which oversees aspects that can include personal careassistance, companion services, behavior focus, behavioralanalysis/therapy, behavioral transportation and tracking, andresidential habilitation. Billing records 240 are generated includingattendance data and service logs. The claims generator 250 generatesprofessional and institutional claims. Claim submission 260 can bemanual and/or Medicaid 270 claims.

Individual Budget Amount (IBA). Users are required to create anIndividual Budget Amount (IBA) to start the Individual Budgetingprocedure. Users assigned with the IBA Approve role will be able tocreate a new IBA. Users of Oversight Account can click on the Createlink below IBA option under the Individual Budgeting section from User'sUnified Dashboard (FIG. 3), which will take users to the Individual Listpage (FIG. 4) where users can select the Individual for creating theIBA. After clicking on the ‘Create New’ button on the IBA page, usersassigned with the IBA Exception Amount role will be able to specify theamount for IBA and the information will be saved after clicking on the‘Save’ button. The above procedure will create a new IBA for theIndividual. Users may also discontinue this IBA by clicking on the‘Discontinue’ button or create a new IBA after discontinuing theexisting IBA using the ‘Discontinue and Create New’ button. Users mayview IBA by clicking on the Search link below the IBA option under theIndividual Budgeting section from the Unified Dashboard. This actionwill open the IB-IBA Search page. Users then enter the name of theIndividual and by clicking on the Search button, the IBA information ofthe individual will be shown.

IB Individual Budget. Once an IBA has been created for an Individual,users with the Budget Create role will be able to create a Budget for anIndividual (FIG. 5). Users can click on the Create link for Budget underthe Individual Budgeting section from the Individual tab on theDashboard. For the Oversight Account, users can click on the Create linkunder the Budget section of the Unified Dashboard. This action will takeusers to the Individual List page and users can select the Individualfrom the list. The Create New Budget page will then open where users canenter the Applicable IBA, Form Date and To Date of the Budget for theIndividual. After users clicking on the ‘Save’ button, a message ofSuccessfully Saved Budget with Form ID will be shown. Users can click onthe ‘Show Budget’ link and they will be taken to the Budget page of theIndividual.

In the Budget page, users may add Service Authorization(s) for theIndividual within the Budget period (FIG. 6). Users can add service byclicking on the ‘Add Service’ button under the Service Authorizationsection in the Budget page. This will open the Service Authorizationpage. Users can then select the Service, From Date, To Date and TotalUnits to be provided. Users can specify the Authorization Number andComments if any and then click on the ‘Next’ button. The ServiceAuthorization Date Range must be within the Budget period. Otherwiseusers will receive a message of Data Range must be within BudgetDuration. This will let users enter further information. Users canselect the Service Provider from the drop-down which provides users withthe name of the Providers managing the Service specified in the ServiceDirectory. Users can select the Service Rate and if the rate is notfixed, users can mention it in the Rate Amount/Unit field. Users willhave a ‘Quick Calculator’ with a small calculator icon to calculate RateAmount/Unit.

After clicking on the ‘Next’ button, users will arrive at the ServiceAuthorization page (FIG. 7). Monthly Allocation units must not exceedTotal Unit of Service Authorization. Users may allocate Service unitsusing options of Allocate Total Unit(s) or Allocate Month Day(s). Ifusers use Allocate Total Unit(s) link, this will allocate the totalunits uniformly across the months. If users use the Allocate MonthDay(s) link, this will allocate the total units depending on the numberof days in the month. Necessary information will be saved after clicking‘Save’ button. A message of Successfully Added Service to the Budgetwith Authorization Form ID will appear once the Service is added to theBudget for the Individual. Users click on the Show Budget link and thiswill take users to the Budget page. After adding the ServiceAuthorization to the Budget page, users may click on the Edit link orDelete link to edit the information added for the particular ServiceAuthorization or deleting the Service Authorization. Users are also ableto view the status of Service Authorization on the Budget page and canidentify whether the Service Authorization has been sent to a Provideror not.

Users can submit a budget by scrolling down to the bottom of the Budgetpage and click on the ‘Submit’ button. This will change the status ofthe Budget from ‘Draft’ to ‘Pending Approval’. Users may also delete thebudget created using the ‘Delete’ button. Users with the Budget Reviewrole will be able to add reviews to Budgets in ‘Pending Approval’ or‘Rejected’ status. To add reviews, Users can click on the count besidethe Pending Approval or Rejected links. For Oversight account, users canclick on the Pending Approval link under the Budget section of theUnified Dashboard. Then, users can select the budget from the PendingApproval Budget(s) page, and scroll down to the bottom of the Budgetpage and click on the ‘Add Review’ button. This will open a Review page(FIG. 8) where users can enter their review and then can click on the‘Save’ button. A message of Successfully Added Review for Budget withFrom ID will appear after clicking on the Save Button.

The budget and plan are available to team members through the systembased on roles and caseloads as described in U.S. Pat. No. 8,281,370.

In the next step, the budget is reviewed by a supervisor. If thesupervisor approves the budget and plan, each service authorizationwithin the plan is sent to a provider agency that can provide theservice. Users with the Budget Approve role will be able to approveBudgets in Pending Approval status. To approve a Budget, users can clickon the count appearing beside the Pending Approval link. For Oversightaccount, users will click on the Pending Approval link under the Budgetsection of the Unified Dashboard. Then, users select the budget from thePending Approval Budget(s), scroll down to the bottom of the Budget pageand click on the ‘Approve’ button. This will change the status of theBudget from ‘Pending Approval’ to ‘Approved’. Users will be taken toBudget page and click on the Approve button. After clicking on theApprove button, a success message of Shareable Services Authorization(s)has been sent to Provider. Budget Approve Successful with Form ID willshow. Users may also reject the budget by clicking on the ‘Reject’button. This will change the status of the Budget from ‘PendingApproval’ to ‘Rejected’.

Budgets having IBA Exceptions or services with a rate type ‘Range’ whoserate has exceeded the maximum amount specified in the Service Directorywill need a special approval. Users with Budget Special Approve role canapprove these Budgets. A count will appear for these budgets against the‘Pending Approval’ link under the Budget section. Budgets that arerejected can be resubmitted for approval. In order to resubmit a budget,users can have the Budget Create role. To resubmit a budget which hasbeen rejected, users click on the count appearing beside the Rejectedlink. For Oversight account, users click on the Rejected link under theBudget area of the Unified Dashboard. This will take users to theRejected Budget(s). Users can select the budget from the list, and makenecessary changes to the service authorization(s). Then users can clickon the ‘Submit’ button. This will change the status of the Budget from‘Rejected’ to ‘Pending Approval’. A budget in ‘Draft’ or ‘Rejected’status can be deleted by clicking on the ‘Delete’ button. This willchange the status of the Budget from ‘Draft’ or ‘Rejected’ status to‘Deleted’ status.

To view the list of Budgets in different status, Users click on theSearch link for Budget under the Individual Budgeting section from theIndividual tab on their Dashboard. For Oversight account, users click onthe Search link under the Budget area of the Unified Dashboard. Thiswill open the IB— Budget Search page where users can enter theappropriate parameters to get the Budget users are looking for. Userswill be able to edit IBA, Applicable IBA and Duration of an approvedBudget. This will change the status of an ‘Approved’ Budget to ‘PendingChange Approval’. Users with the Budget Approve role can approve theBudget with changed IBA, Applicable IBA and Duration. However, userswill be unable to change the Budget duration if Service Consumptionunits are already recorded for the duration and will receive a messageof Service Already Added for Date Range.

Providers. Providers can be institutional, such as a hospital,healthcare organization, educational or penal facility, or anindividual/independent provider. FIG. 35 outlines the hierarchy ofprovider and service roles. Linked providers are providers that arelinked to an agency, such as a state or federal agency. The agency hasan oversight account to access the information in the system.Independent Providers, also known as Non-Specialized Providers, arepeople who have signed up to become Agency Providers so that they canprovide services, generally to individuals receiving services who aredirecting those services for themselves. These independent providers areoften friends or neighbors of the service recipients. Independentproviders may provide non-specialized services, such as housecleaning orother general assistance. For scale, Nebraska has about 40 Provideragencies and over 1000 Independent Providers. The disclosed system andmethods provides an automated process which simplifies account creationfor the agency overseeing the Provider (the “Oversight Agency”), andaccount use for Independent Providers. This replaces a cumbersomeprocess of sending and receiving paper forms followed by data entry.When a new Independent Provider registers with Medicaid, with one click,the state can create a Provider Account with all the correct attributes,set up, and linked and ready to receive referrals and serviceauthorizations as described elsewhere. The Provider Account has only oneuser which is automatically created with the right permissions to beable to receive Service Authorizations, collect data, submit claims, andreceive remittance advice for one or more individuals that they areproviding services to. One of the advantages of the disclosed system isthat both the specialized and non-specialized/unmapped providers can beintegrated within the system and billing/payment can be processedelectronically for any type of provider. This process allows forquicker, more accurate collection of data and faster payment of claimswhile meeting Medicaid requirements for audit.

IB Send Service Authorization to a Linked Provider—For ServiceCoordinators. Within the Individual Budgeting module, ServiceCoordinators can send Service Authorizations to Linked Providers. Userswill require appropriate roles, such as one or more of an IBA Approverole, Budget Create role, Budget Review role, Budget Approve role and/orBudget Special Approve role (FIG. 34) in order to be able to create anIndividual Budget Amount (IBA) or Individual Budget and to send ServiceAuthorization to a Provider. Users can click on the Create link underIBA in the Individual Budgeting section on Unified Dashboard of theOversight Agency account (FIG. 3). This will take users to theIndividual List page where users can select the Individual for creatingthe IBA. Users may filter the list by typing the name of an Individualin the Individual Name text-box at the top. By clicking on theIndividual's name from the Individual List, Users will be taken to theIBA page. Users may enter the first few letters of the Individual Nameand an auto complete list will appear showing possible matches. Userscan select the particular Individual Name from the list. On the IBApage, Users then click on the ‘Create New’ button to create a budget forthe Individual. Users can enter the amount for the Individual budget inthe Amount field and then click on the ‘Save’ button to save theinformation. This will create a new IBA for the Individual. Users maydiscontinue this IBA by clicking on the ‘Discontinue’ button or create anew IBA after discontinuing the existing IBA using the ‘Discontinue andCreate New’ button. Only one active IBA can exist for an Individual inthe system.

To create an individual budget, Users can click on the Create link underBudget area in the Individual Budgeting section on their UnifiedDashboard of the Oversight Agency account. This will take users to theIndividual List page. Users can select the Individual from the list.Users may filter the list by typing the name of the Individual in theIndividual Name text-box at the top of the page. Clicking on theIndividual's name will take users to the Create New Budget page. Userscan then enter the Applicable IBA, Form Date and To Date of the Budgetfor the Individual under the Create New Budget section. After clickingon the ‘Save’ button, the draft of the Individual Budget will be savedand users will be directed to the Budget page of the Individual. Hereusers may add Service Authorization(s) for the Individual within theBudget period.

To add service authorization, on the Budget page, users can click on the‘Add Service’ button to add a Service Authorization to the budget usershad just created. This will open the Service Authorization page. Userscan select the Service, From Date, To Date and Total Units to beprovided, and specify the Authorization Number and Comments if any.Clicking on the ‘Next’ button will let user enter further information.The Service Authorization Date Range must be within the Budget period.Users can select the Service Provider from the drop-down which providesusers with the name of the Providers managing the Service specified inthe Service Directory. Users can select the Service Rate and specify therate type and then click on the ‘Next’ button to proceed further. TheMonthly Allocation section will then appear on the Service Authorizationpage where users can allocate the service units for each within thebudget period. Users may allocate the total unit uniformly by clickingon the Allocate Total Unit(s) link or Allocate Month Day(s) link.Monthly Allocation units must not exceed Total Unit of ServiceAuthorization. Once users are done, users can click on the ‘Save’ buttonto save the necessary information. This will take users back to theBudget page. After adding the Service Authorization to the Budget page,users may click on the Edit link or Delete link to edit the informationadded for the particular Service Authorization or deleting the ServiceAuthorization.

Users may add another Service Authorization to this budget by clickingon the ‘Add Service’ button. For Submitting Budget, users click on theDraft link under Budget area in the Individual Budgeting section ontheir Unified Dashboard of the Oversight Agency account. This will takeusers to the Budget List page. By clicking on the particular Form IDfrom the list that users would like to open, users will be taken to theBudget page. By clicking on the ‘Submit’ button located at the bottomright corner of the Budget page, the status of the Budget will changefrom ‘Draft’ to ‘Pending Approval’. For approving the budget, usersclick on the Pending Approval link under Budget area in the IndividualBudgeting section on Unified Dashboard of the Oversight Agency account.This will take users to the Budget List page. By clicking on theparticular Form ID of the Budget that users would like to open, userswill be taken to the Budget page. On the Budget page, users can scrolldown to the bottom of the page and click on the ‘Approve’ button toapprove the Budget form. A message of Budget Approve Successful forIndividual will appear on the Budget page confirming the successfulapproval of the Budget.

Users can also send service authorization to a provider by clicking onthe List link under Budget area in the Individual Budgeting section onUnified Dashboard of the Oversight Agency account. This will open theBudget List page. Users can search for a particular Budget by specifyingsearch criteria such as: Individual Name, Form ID, Status etc. andclicking on the ‘Search’ button. Users will be taken to the Budget pageby clicking on the Form ID of the Budget that will be listed based onusers search criteria. On the Budget page, users can click on the SendTo Provider link available under the Service Authorization section inorder to send the Budget to a Provider. This will take users to theService Authorization Submission page. Users then click on the ‘Send’button to send this Service Authorization to the mapped Provider for themapped Individual. A message of Successfully Submitted ServiceAuthorization will appear on the Budget page of the Individual once theService Authorization has been submitted to the Linked Provider Agency.The status of the Service Authorization will also be displayed on theBudget page indicating the date and time when the Service Authorizationhas been sent to the Provider agency. If the Service Authorization isupdated after it has been sent to the Provider, then a message appearsto describe the status of the Service Authorization.

IBA Exception. Users with IBA Exception Create and IBA Exception Amountroles will be able to add IBA Exceptions to Individual's Budget. Userscan click on the Search link for Budget under the Individual Budgetingsection from the Individual tab on their Dashboard. From users UnifiedDashboard (For Oversight Agency users), users click on the Search linkfor the Budget section. This will open the IB-Budget Search page. Enterusers search parameter as appropriate. From the search result, users canclick on the Form ID of the budget. User then will be taken to theBudget page. Clicking on the ‘Add IBA Exception’ button under the IBAException section will take users to the IBA Exception page where userscan add IBA Exception Description, Exception Amount, Date range andCategory. By clicking on the ‘Save’ button to save the IBA Exception,the status of IBA will change to ‘Draft’ and users will receive themessage of IBA Exception Save successful for individual.

To submit the IBA Exception for approval, users can click on the Draftlink for the IBA Exception option from Unified Dashboard/Dashboard. Fromthe Draft IBA Exceptions page, users can select the particular IBAException. By clicking on the ‘Submit’ button to submit the IBAException, the status of IBA will change from ‘Draft’ to ‘PendingApproval’. Then user will receive the message of IBA Exception Submitsuccessful for individual. Users with IBA Exception Review role will beable to add reviews to an IBA Exception. To add a review, users canclick on the List link under the Individual Budgeting section of theUnified Dashboard or beside the IBA Exception from the Individual tab onuser's Dashboard. Users will be taken to IB-IBA Exception Search pageand can enter the search parameter as appropriate. Users can select theparticular IBA Exception from the search result. After opening theparticular IBA Exception, users can click on the ‘Add Review’ button toadd reviews (FIG. 9). This will open the IBA Exception Review page (FIG.10) where users can enter reviews. Users can click on the ‘Save’ buttonto save review. Users cannot add reviews to an already approved IBAException. Users will receive the success message of IBA ExceptionReview Added Successfully.

Users with IBA Exception Approve role will be able to approve an IBAException. Users will be able to view IBA Exceptions that are yet to beapproved from the Pending Approval link for IBA Exception under theIndividual Budgeting section of Unified Dashboard or by clicking on thePending Approval link beside the IBA Exception option from theIndividual tab of their Dashboard. Users will then be taken to thePending Approval IBA Exception(s) page, and can select the particularexception. Users can click on the ‘Approve’ button on the IBA Exceptionpage to approve the IBA Exception. Users may also reject by clicking onthe ‘Reject’ button. Users will receive the success message of IBAException Approve Successful for Individual when users approve, andreceive the success message of IBA Exception Reject Successful forIndividual if users reject. Rejected IBA Exceptions can again besubmitted for approval. Once submitted, it will change the status of theIBA Exception from ‘Rejected’ to ‘Pending Approval’.

IB IBA Exception Category. Provider Administrators or Users with IB DataAdmin Module role are able to create and view IBA Exception category.Provider Administrators or Users with ‘User’ Administrative role canenable the IB Data Admin Module role for the user account (FIG. 11).

To create an IBA Exception Category, users can click on the IBAException Category Create link for IB Data Admin under the IndividualBudgeting section from the Individual tab on the users Dashboard. Thiswill take users to the IBA Exception Category Create page where userscan scroll to the Category Name and click on the ‘Save’ button. Asuccess message of Successfully Saved IBA Exception Category will appearon saving the IBA Exception Category. In order to access IBA ExceptionCategory List, users can click on the IBA Exception Category List linkfor IB Data Admin under the Individual Budgeting section from theIndividual tab on their Dashboard. This will take users to the IBAException Category List page where users will find the IBA Exceptioncategories created. Users can click on the Show link to select the IBAException category that want to edit or delete and this will open theIBA Exception Category page where users may edit or delete the IBAException Category.

Selecting Waiver on a Budget—For Service Coordinator Supervisors.Service Coordination Supervisors can select a waiver for Waiver ProgramEnrollment on an individual's budget. The Budget needs to be in ‘PendingApproval’ status. To do so, users can click on the Pending Approval linkunder the Individual Budgeting section on Unified Dashboard, users willthen be taken to the Pending Approval Budget(s) page. Users will selecta Budget from the list of budgets with ‘Pending Approval’ status. Thiswill open the budget form. Users can select the appropriate Waiver fromunder the Waiver Program Enrollment section. After users selected thewaiver, users can scroll down to the bottom of the page and click on the‘Approve’ button to approve the budget.

Acknowledge a Service Authorization—For Linked Provider Users. When aService Coordinator sends a Service Authorization to a Linked Provider,the users at the Linked Provider can acknowledge that ServiceAuthorization. They will receive a count under the Individual Budgetingsection on their To Do tab of the Dashboard for the ServiceAuthorizations that they can acknowledge. In order to be able toacknowledge Service Authorizations, users can have appropriate accessprivileges on the Individual and will also require the IB ProviderService Authorization. The Acknowledge role is assigned to therespective user accounts. If the users find any discrepancies in theService Authorization, then they can contact the Service Coordinatorregarding this.

In order to Acknowledge a Service Authorization, Users can click on thenumber beside Acknowledge under the Service Authorization section in theTo Do tab (FIG. 12). This will open the Service Authorization list page.When users click on a Form ID of the Service Authorization that userswould like to open, it will take users to the Service Authorizationpage. On the ‘Billing Service Authorization’ section of the page, userscan select the Program (Site) where the service will be provided to theindividual using the dropdown menu. After users have done so, users canclick on the ‘Acknowledge’ button. Users will receive the successmessage of Successfully Acknowledged Service Authorization and thestatus of the Service Authorization will be changed from ‘Pending’ to‘Acknowledged’.

Acknowledging the Service Authorization will create a Billing ServiceAuthorization which will be used to generate Billing Claims for theservices provided. The system will automatically record ServiceConsumptions using the submitted claims. Users can access the BillingService Authorization form from the Service Authorization by clicking onthe link beside ‘Form ID:’ under the ‘Billing Service Authorization’section. Users can also Contact the Service Coordinator via SComm ifthey find any discrepancies in the Service Authorization; users shouldcontact the Service Coordinator who sent the Service Authorization totheir agency. Users may contact the Service Coordinator via the SecureCommunication (SComm) module. In order to be able to send SComm messagesto user's Service Coordinator, the user's account can be assigned withthe Multi Provider SComm role. To send a Scomm message to the ServiceCoordinator, Users can click on the Compose link under the SecureCommunications area on their Dashboard and choose ‘General’ option asthe type of SComm message. In the ‘Select Recipient’ area, users canselect the ‘Provider’ tab and click on the name of the country, state,or city, such as, for example, Nebraska. Users then select on the checkbeside the name of the Service Coordinator users want send the SComm toand click on the ‘Add’ button. This will add the Service Coordinatorunder the ‘Recipient(s)’ area. In the ‘Message & Options’ area, userswill select Notification Level, enter Subject and then type in messageabout the discrepancies users have found in the Service Authorization.Once users are done, they can click on the ‘Send Message’ button at thebottom of the page.

Each agency can see its own authorization as well as the whole plan. Theagency reviews the authorization and can choose to accept or reject theauthorization through the system. If the agency refuses theauthorization, the system alerts the supervisor and/or other teammembers to the refusal.

If the agency accepts the authorization, an attendance log isautomatically generated by the system. This attendance log allows directsupport staff to enter data in real time as to when the individual waspresent and received the authorized service.

Setting up Attendance Type For Linked Providers. To enter Attendance tosubmit consumed units to the Oversight, users can create a newAttendance Type and configure a Service Description to use thisAttendance Type. To create a new Attendance Type, users can click on the‘New Attendance Type’ link on the ‘Billing’ Section under the Admin tabof the Dashboard (FIG. 13). Users can enable the User for IB option byclicking on the checkbox. Then provide a Type Name. If users arecreating the Attendance type for a Service with Daily units of measure,users then select the ‘No’ option for the Use Time In/Out field. Ifusers are creating the Attendance type for a Service with Hourly unitsof measure, they select the ‘Yes’ option for the Use Time In/Out field.On the Options section of the form, users can enter one or more OptionName(s) and their corresponding Option Code and/or Billing Units. Underthe Billable column, users can indicate which options will be marked as‘Billable’. If Time In/Out is required, then the Billing Units columnwill be disabled and Billable Units will be calculated from Time In/Out.When users have completed entering all the information, users click onthe ‘Save’ button.

When creating a Service Description, users can specify ‘Attendance’ asthe Method of Data Collection. Users also can select an Attendance Typefrom the Attendance Type dropdown menu (FIG. 14). On the ServiceDescription/Code form, the Used for IB option needs to be set to ‘Yes’to be able to select Method of Data Collection.

Enter and Approve Attendance Data: Users with the Attendance Data Submitrole will be able to view the Attendance section on the Billing tab ontheir Dashboard. To enter/record Attendance Data, users will need anapproved Service Authorization. In order to Enter Attendance Data, Userscan click on the New link beside the Attendance section under theAttendance area on the Billing tab on their Dashboard. The SearchService for New Attendance page will open. Then users can select theService Date as appropriate and then select the Attendance Type Namefield. When users select the Attendance Type Name, the ServiceDescription (Code) will list options depending on the selectedAttendance type. When the Service Description (Code) is selected, theProgram (Site) field will populate depending on the programs linked tothe particular Service Description (Code). Once users have selected allthe parameters (as appropriate), click on the ‘Search’ button to viewthe Attendance Grid. The Individual list will contain all theindividuals having Service Authorizations under the selected Programwith the specific Service Description Code. Users can enter Attendanceinformation for multiple individuals at the same time. New AttendanceData can only be entered from the New section under the ‘Input’ tab ofthe Attendance Grid (FIG. 17).

On the Attendance page, Users can select the Attendance Option (Present,Absent etc), Time In/Time Out and select the Individuals for whom userswill enter data. For midnight time calculation, users can enter 12:00am/Midnight as Time Out: from the Attendance Grid on the Attendance DataUpdate page (FIG. 18). Once users have selected all the fields asappropriate, users click on the ‘Submit’ button to submit the entries.Once the attendance entries have been submitted, these entries will bein In Prep status. In many cases, time in/time out is not required byusers, for such scenarios users may leave the Time In/Time Out fieldsblank This will give users a prompt to make sure that users are doing itintentionally. For example, for an Attendance Option like ‘Absent’, itis not logical to put Time information, so users can skip by notentering Time In/Out. In order to record attendance data with only theTime In field, users can specify just the Time In and submit anAttendance Data. Users will receive a message once they try to submit anAttendance record with the ‘Time In’ specified and not the ‘Time Out’.Users will click on ‘Yes’ to submit the Attendance record with just the‘Time In’. Attendance Data having just the Time In and no Time Out willremain in Incomplete state and cannot be approved unless Time Out isspecified later on. From the ‘Incomplete’ section on the Attendancepage, users enter the Time Out and select one or more Individuals byclicking on the check-boxes. Users click on the ‘Submit Incomplete’button to submit the incomplete Attendance record.

For adding a service provider, if a ‘Service Provider’ is added from theService Provider drop-down menu while recording Attendance data, userswill view a 1 in the red notification box appearing next to the‘Attendance option’(e.g. ‘P’, ‘A’ etc) on the Attendance grid even whenthere is no Time In/Out information provided. The ‘1’ in the rednotification box signifies that there is no Time In/Out informationrecorded and that Service Provider information has been added. Movingthe cursor to the red ‘1’ will display a message stating that the TimeIn/Out is not provided. Users will be able to view the details of theAttendance type (specified for the particular Service Authorization)from the Attendance Type Details link located at the top-left corner ofthe Attendance page. For approving attendance data, users withAttendance Data Approve role will be able to approve Attendance Data inIn Prep state from the Approve tab of the Attendance Grid. On theApprove tab, users will select the appropriate attendance entries thatcan be approved and click on the ‘Approve’ button.

Once an Attendance Data is approved, a success message of SuccessfullyApproved will appear at the top of the Attendance page and the data isshown in Green color. Approved Attendance Data can be updated by usershaving Attendance Data Update Role. For generating billing data, userswith both Attendance Data Approve and Billing Data Submit roles will beable to generate billing data from the ‘Generate Billing Data’ tab inthe main Attendance Grid. Users can only generate Billing Data fromApproved Attendance Data. Once Billing Data is generated from AttendanceData, it will be shown in Orange color. On the Generate Billing Datatab, users will select the Individuals for whom users require togenerate billing data. A success message of Successfully Submitted ForBilling will appear on generating the Billing Data. Users can click onthe ‘Ok’ button to get back to the Attendance page. The Attendance databox will be marked orange to indicate that it has been submitted forBilling. For changing attendance data status from “Submitted forBilling” to “In-Prep”, Attendance data that has been Submitted forBilling can be changed back to In Prep if no billing data was generatedfor that particular day. At the bottom of the Attendance Data Updatepage, users can click on the Reset Status to In Prep button to changethe status of the Attendance Data that was Submitted for Billing to InPrep. Once the status of an attendance data has been changed from‘Submitted for Billing’ to ‘In Prep’, the Attendance Grid will displaythat Attendance Data in In Prep status. For Attendance data that hasbeen updated to In Prep status (from ‘Submitted to Billing’ status), onthe respective Attendance Data Update page users will view the message“Attendance Status was changed from Submitted for Billing to In Prep”.

An agency supervisor can review and approve the attendance data. Accessto the attendance data and supervisory review can be limited based onroles and caseloads of other members providing services as described inU.S. Pat. No. 8,281,370.

If the agency supervisor approves the attendance data, the systemforwards information to the agency's finance staff for billing. Thefinance staff can then easily generate claims through the automatedprocess as described in U.S. Pat. No. 8,281,370.

Create New Funding Source—For Linked Providers. From the Admin tab onthe users' Dashboard, users click on the new link for Funding Sourceunder the Billing section. In the Funding Source page, users can enterthe Name of the Funding Source, complete the Contact Informationsection. Users must select NFOCUS from the Payer drop-down field forElectronic Billing.

IB Create & View Funding Component. Oversight Agency users with IB DataAdmin module role are able to create Funding Component. They can viewfunding components from the Funding Component List. To create a FundingComponent, users can click on the Create Funding Component link underthe IBA Worksheet section of Individual Budgeting module. Users will betaken to the Funding Component page. Users will enter the FundingComponent's name in the Funding Component Name: field and click on the‘Save’ button. Users will be taken to the Funding Component List page.On this page, users will see a statement confirming the successfulsaving of the Funding Component. Users may click on the Show linkassociated with the Funding Component to view it. Users will be taken tothe Funding Component page. In addition, users can create anotherFunding Component by clicking on the ‘Creating Funding Component’ buttonlocated at the bottom of the Funding Component List page. Users can editthe Funding Component. After making any necessary edits, users simplyclick on the ‘Save’ button located below to save the changes. Users mayalso discontinue the Funding Component by clicking on the ‘Discontinue’button located at the bottom right corner of the page. To view a FundingComponent, users click on the Funding Component List link under the IBAWorksheet section of Individual Budgeting module. Users will be taken tothe Funding Component List page. Users then can enter the name of theFunding Component in the Funding Component Name field and press the‘Enter’ key on their keyboard. This will filter out the FundingComponent that users wish to view. Users can also discontinue its statusor edit it by clicking on the Show link associated with it.

IB Create & View Funding Component Status. To create a Funding ComponentStatus, users click on the Create Funding Component Status link underthe IBA Worksheet section of Individual Budgeting module. Users will betaken to the Funding Component Status page. Users can enter the name ofthe Funding Component Status in the Funding Component Status: field andclick on the ‘Save’ button located at the bottom right corner of thepage. Users can also make it Reportable by clicking on the checkboxbeside Reportable option. Users will be taken to the Funding ComponentStatus List page. On the Funding Component Status List page users willsee the confirmation statement of Successfully Saved Funding ComponentStatus ‘Pending’ indicating that the Funding Component Status has beenstored in the system. Users can also create another Funding ComponentStatus by clicking on the ‘Create Funding Component Status’ buttonlocated at the bottom right corner of the page. To view a FundingComponent Status, Users can click on the Funding Component Status linkunder the IBA Worksheet section of Individual Budgeting module. Userswill be taken to the Funding Component Status List page. Users can enterthe Funding Component Status name in the Funding Component Status fieldand press the Enter key on user's keyboard. This will filter out theFunding Component Status that users wish to view. Users can also editthe Funding Component Status or discontinue it by clicking on the Showlink associated with it on the Action Column.

IB IBA Worksheet. The IBA Worksheet will enable Oversight Agency userswith IB Data Admin Module role to associate funding components to anIndividual, and specify amount, date range and comments. To create anIBA Worksheet, from their Unified Dashboard (Oversight Account), Usersclick on the IBA Worksheet link under the IBA Worksheet section ofIndividual Budgeting module. Users will be taken to the Individual Listpage. Users select the Individual for whom users want to create an IBAWorksheet from the list. Then users will be taken to the IBA Worksheetpage. Users may also filter out the Individual's name by specifying thename in the Individual Name field. If users enter the first few lettersof the Individual Name, an auto complete list will appear showingpossible matches. Users can select the particular Individual Name fromthe list and click on the ‘Search’ button to filter out. If anIndividual has more than one approved Budget then the IBA Amount andApplicable IBA of the last approved Budget will appear under the IBAWorksheet. The Utilization Rate (%) field has been added under the IBAWorksheet section. On the IBA Worksheet page, IBA Amount and ApplicableIBA from the last approved budget of the Individual are displayed. Userscan add funding components in the IBA Worksheet Component section byclicking on the ‘Add Funding Component’ button located at the bottomright corner of the page. Users can also edit the existing components byclicking on the Edit link associated with each one in the row under theAction column (FIG. 28). After clicking on the ‘Add Funding Component’button, users will be taken to the IBA Worksheet Component page. Usersenter information in the appropriate fields under the IBA WorksheetComponent section and then click on the ‘Done’ button located at thebottom right corner of the page. This will take users back to the IBAWorksheet page. In addition, users may add negative values in the Amountfield and amounts with negative value will appear in parenthesis. Userswill see a warning statement saying “This section has been modified butnot saved” on the IBA Worksheet page. To save the change, users canclick on the ‘Save’ button located at the bottom right corner of thepage. If the IBA Worksheet was updated previously, users will see theUpdate History link at the top of the pages. Clicking on it will showthe update history.

IB Billing Document. Linked Provider Users are required to have the IBProvider Data Admin Module role to create and access a Billing Document.Linked Provider users will be able to create a Billing Document forService Authorization(s) which has been sent to them by OversightAgency. Provider Administrators or Users with ‘User’ Administrative rolecan enable the IB Provider Data Admin Module role for their accounts(FIG. 25). To create a Billing Document, users click on the CreateBilling Document link for IB Provider Data Admin under the IndividualBudgeting section from the Individual tab on their Dashboard. This willtake users to the Create IB Billing Document page. On this page, Usersenter a unique Claim Number, Service Provider Code, Billing Month andselect the Oversight Provider. Then users click on ‘Next’. Users willreceive an error message for the Service Provider Code stating ‘ServiceProvider not found with the code’ after clicking on ‘Next’, if theService Provider is not mapped with the Linked Provider from theOversight end. Clicking on ‘Next’ will take users to the page whereusers may enter the Authorization Number. Users can select theAuthorization Number from the auto-populated list and click on ‘Next’.To have the Authorization Number field auto-populate, the Authorizationnumber must be assigned by the Oversight Agency and the ServiceAuthorization must be sent to the Linked Provider. This will add theService Authorization information on the Billing document. Users canclick on the ‘Save’ button to save the information (FIG. 26). A successmessage of Successfully Saved Billing Document will be generated onsaving the Billing Document.

Users can click on the Billing Document List link for IB Provider DataAdmin under the Individual Budgeting section from the Individual tab ontheir Dashboard. This will take users to the IB Billing Document Listpage. Users click on the Show link to view the particular IB BillingDocument. This will open the IB Billing Document page where users mayfetch the Service Consumption record using the ‘Fetch’ button at thebottom of the page. Clicking on the ‘Fetch’ button will display theService Consumption record(s). Users can select the Service Consumptionrecord for the IB Billing Document and click on the ‘Save’ button. Asuccess message of Successfully Saved Billing Document will appear onsaving the IB Billing Document. Users may click on the ‘Edit’ button atthe bottom of the IB Billing Document page to edit the IB BillingDocument Information. This will allow users to select a differentService Authorization sent by the Oversight agency and different ServiceConsumption record(s) (FIG. 27). Only Service Consumption recordsaccepted by the Oversight agency will appear under the ServiceConsumption(s) column on the IB Billing Document page. Users can clickon the ‘Save’ button to save the changes.

Create New Billing Data for Linked Providers. To generate Billing data,Users click on the New link, in the Billing Data row on the ProfessionalClaim section under the Billing tab of their Dashboard (FIG. 15). In theSearch Service for New Billing Data page, users enter the appropriatesearch parameters. For the Individual Name field, typing in the firstfew letters of the name will show a drop-down list with names that matchthe entered name. Users can click on the correct name from the list. Thesearch result will be displayed according to the search parameters. Atthe Billing Data page, users enter all appropriate information in the‘Billing Data Input’ section, the fields marked with a red asterisk (*)are required (FIG. 24). When users have completed entering theinformation, users can click on the ‘Submit’ button.

Creating Billing Provider—For Linked Providers. From the Dashboard,users click on New in the same row as Billing Provider under Billing,which can be viewed in the Admin tab (FIG. 23). In the Billing Providerpage, users can enter information in all fields marked with asterisks(*). Users can enter the ID Types as EIN (Employer's IdentificationNumber) Number. The EIN Number must be the same as the Provider Code ofthe Service Provider. Users will find the Provider Code on the IBService Authorization sent to users by the State Agency. On the BillingProvider form, users may select the ‘Employer's Identification Number’option for ID Type and enter the Provider Code found on the IB ServiceAuthorization to the ID Number field. Users may enter NPI Number andProvider Commercial Number if appropriate. Alphanumeric values(consisting of or using both letters and numerals) can be entered in theNPI Number field. Users can enter Provider Address as appropriate; P.O.Box number is not required for the Provider address. The ZIP fieldaccommodates 9 digit zip codes. A Warning message is displayed if theZIP code entered is not 9 digits long. Users also can enter ContactInformation and other details of the Provider as appropriate. Once usershave entered all the information, users simply click on the ‘Save’button to save the form.

Creating New Service Description Code for Linked Providers. In theDashboard, users click on the New link in the same row asDescription/Code under Billing in the Admin tab. On the ServiceDescription/Code page, users enter the Service Description by insertingthe non-numeric part of the Service specified on the IB ServiceAuthorization (for example, ‘DEMO Description’ from ‘8244—DEMODescription’), followed by a space and then enter the Unit of Measurespecified on the IB Service Authorization. Users then enter the ServiceCode from the numeric part of the Service specified on the IB ServiceAuthorization (for example, ‘8244’ from ‘8244—DEMO Description’) (FIG.16). Users may select the appropriate Claim Type and all other fieldsmarked with a red asterisk (*). Users then select the Method of DataCollection as specifying by their agency. If users select the‘Attendance’ option, users can also select the appropriate AttendanceType that will used to record Attendance. Once users have entered theappropriate information they can click on the ‘Save’ or ‘Save and CreateNew’ button as appropriate.

IB Oversight Agency accepting unit consumption submitted by the LinkedProvider users. For oversight agency accepting unit consumptionsubmitted by the Linked Provider users, once recorded serviceconsumption has been submitted to the Oversight Agency for approval, theSubmitted Units link with a count will appear under the To Do tab onDashboard for the Oversight user. Users click on the Submitted Unitslink under the Individual Budgeting section on Unified Dashboard. Thenusers will be taken to the Submitted Consumed Unit List page. Afterclicking on the View link in a particular row under the Action Columnfrom the Submitted Consumed Unit List page, users will be taken to theSubmitted Consumed Unit(s) page. Users may also select and approve allsubmitted consumed unit by selecting the checkbox beside the Form IDcolumn and then click on the ‘Approve’ button at the bottom of theSubmitted Consumed Unit List page (FIG. 22). Users may click on the‘Approve’ button located at the bottom of the Submitted Consumed Unit(s)page to accept the submitted consumed unit(s). Users may enter theircomments while accepting or rejecting used units submitted by LinkedProvider users. These comments can be viewed by the Linked Providerusers who submitted the used units and can be referred to by the userswhile re-submitting the used units. Users may reject the submittedconsumed units by clicking on the ‘Reject’ button. This will change thestatus of the submitted consumed units as rejected. A message ofConsumption Unite(s) exceeded the total monthly allocation will be shownon the Submitted Consumed Unit(s) page if the units used exceeded thetotal monthly allocation. By clicking on the ‘Approve with ExceededUnit(s)’ button located at the bottom of the page, users will be able toaccept the used submitted units. A confirmation message of SuccessfullyApproved Service Consumption will appear on the Submitted Consumed UnitList page after the successful approval of the Service Consumptionrecord.

Updated IB Share of Cost. Users with the IB Data Admin role will be ableto update IB Share of cost for an Individual by clicking on the Listlink beside the IB Share of Cost option under the Individual Budgetingsection from the Individual tab on their Dashboard. Users will be takento the Share of Cost List page. From the Search section, users maysearch for the Share of Cost by entering the Individual name, month oryear. From the ‘Share of Cost List’ section, users may also click on theShow link under the Action column. Users will be taken to ‘Share ofCost’ page of the Individual. To update the Share of Cost, users canenter the new amount in the ‘Amount’ field and click on the ‘Update’button. To edit the customer obligation, users may click on the Editlink under the Action column, then enter the new amount and click on the‘Save’ button (FIG. 21). If the Customer Obligation Amount for aparticular month is edited, all claims that were submitted that monthand are in ‘Sent’, ‘Paid’, and ‘Paid Adjusted’ status will change to‘Billable’ Status. The Patient Responsibility Amount ($) of these claimswill change to the updated Customer Obligation Amount. The claims willthen be automatically re-sent to the Payer.

Submit Service Consumption and Billing Claim for linked providers. Forview and submit service consumption, after users have submitted BillingData to record services provided, the system will automatically generatea claim and use that claim to record a Service Consumption. The ServiceConsumption will be automatically submitted to the Oversight Agency forapproval (FIG. 19). Before the consumed service units are approved, theService Consumption form and the Claim will remain in ‘Pending Approval’status (FIG. 20). After the Service Consumption has been approved by theOversight Agency, then the status of the Service Consumption will changeto ‘Approved’. The status of the submitted claim will change to‘Billable’. Then the claim will be submitted to the Payer (NFOCUS). Formarking a ‘Sent’ claim as ‘Paid’, if users have received the amount thatwas claimed for the service, users may mark this claim as ‘Paid’. To doso, users can search for the claim that is in ‘Sent’ status and updatethe claim status to ‘Paid’ on claim form. Users can click on the Searchlink beside the Professional Claim under the ‘Billing’ tab of theDashboard. On the search page, users enter the search parameters asappropriate. The search result will be displayed based on the searchparameters provided. Users can click on the appropriate Claim ID to viewthe claim form and select the claim that users want to mark as ‘Paid’.On the claim form, users can scroll down towards the bottom of the claimform and click on the ‘Update Status’ button. This will open the ClaimStatus and Amount Update page. Users then select the status as Paid fromthe New Status field and the claim status will change to ‘Paid’.

Delete Service Authorizations with Consumed Units for oversight andlinked providers. If a Service Authorization has consumed services, itcannot be deleted unless the consumed units are changed to zero. Amessage of Service Authorization cannot be deleted as non-zero ApprovedConsumption found will appear. To do so, the Linked Provider can forceany previous paid claims to zero units and send the pending serviceconsumptions recorded to the Oversight Agency for approval. After theOversight Agency approves the zero-ed service consumptions, the ServiceAuthorization will no longer contain any Service Consumptions and can bedeleted.

For Linked Providers to Resend ‘Paid’ or ‘Paid-Adjusted’ Claims withZero Units and to resubmit a claim in ‘Paid’ status, users can click onthe Search link under the Billing tab of the Dashboard, then search andopen the Claim form users want to submit. Users may search the claim byselecting Paid as a parameter from the Claim Status field in the Claimsearch form. Users can scroll down towards the bottom of the claim formand click on the ‘Update for Replacement’ button (located towards thebottom of the form). After the claim form is reloaded on screen, usersclick on the ‘Update’ button at the bottom. On the success message thatappears, users click on the ‘Back to the Claim Form’ link. The status ofthe claim will change to ‘Updating’. Note that the Claim Frequency TypeCode has been changed to ‘7—Replacement (Replace of Prior Claim)’. ForLinked Providers in certain regions, such as, for example, Nebraska,only claims of this type can be submitted as replacement claims. Forclaim forms in ‘Updating’ status, users will be able to edit the BillingData to review any information contained within, such as Total BillableUnits. Users can click on the link below Billing Data ID under the‘Service Lines’ section to open the Billing Data form and make theappropriate changes. To apply the changes, users can click on the‘Update’ button. On the claim form, users click on the ‘Submit forApproval’ button at the bottom to resubmit for approval. A successmessage of The form has been Successfully Submitted will be displayed toconfirm the claim submission. The status of the claim will change to‘Pending Approval’. The Service Consumption recorded from the claim forthe Linked Provider will also contain zero units.

For Oversight Provider to Approve the Service Consumption(s) with ZeroUnits, once the recorded service consumption has been submitted to theOversight Agency for approval, as an Oversight user, users can accessthe service consumptions by clicking on the Submitted Units link underthe Individual Budgeting section on Unified Dashboard. On the SubmittedConsumed Unit List page, users click on the checkbox beside the ServiceConsumption sent with zero units. Then users scroll down to the bottomof the page and click on the ‘Approve’ button to accept the submittedconsumed unit. A success message of Successfully Approved ServiceConsumption(s) will appear at the top of the page. For OversightProvider to Delete Service Authorization, after the Service Consumptionwith zero units has been approved, users can go to the individual'sBudget form. The Service Unit that was previously listed has beenremoved. Users can click on the Delete link indicated. Users then clickon the ‘Delete’ button at the bottom. If the Service Authorization hasbeen deleted, the following success message of Successfully DeletedService from the Budget with Authorization Form ID will appear,confirming the action.

Resubmit Rejected ‘Sent’ Claims—For Linked Providers. Users may resubmita claim in ‘Sent’ status for claims that were rejected by NFOCUS andclaims that were rejected by the Oversight Agency and needs to bereadjusted. In order to resubmit a claim in ‘Sent’ status, users clickon the Search link in the Billing tab of the Dashboard and search forand open the Claim form users want to submit (FIG. 30). Users may alsosearch the claim by selecting Sent as a parameter from the Claim Statusfield in the Claim search form. Then users scroll down towards thebottom of the claim form and click on the ‘Update Status’ button.Clicking on the ‘Update Status’ button will open the Claim Status andAmount Update page. Users select the status as Paid from the New Statusfield. Once the status of the claim has been changed, users click on the‘Update for Replacement’ button (located towards the bottom of theform). After the claim form is reloaded on screen, users click on the‘Update’ button at the bottom. When the success message of The form hasbeen Successfully Updated appears, users click on the ‘Back to the ClaimForm’ link. The status of the claim will change to ‘Updating’. Note thatthe Claim Frequency Type Code has been changed to ‘7—Replacement(Replace of Prior Claim)’. For Linked Providers in a country, state, orcity, such as, for example, Nebraska, only claims of this type can besubmitted as replacement claims. For claim forms in ‘Updating’ status,users will be able to edit the Billing Data to review any informationcontained within, such as Total Billable Units. Users can click on thelink below Billing Data ID under the ‘Service Lines’ section to open theBilling Data form. On the Billing Data form, users can make theappropriate changes and click on the ‘Update’ button. On the claim form,users click on the ‘Submit for Approval’ button at the bottom toresubmit for approval. A success message of The form has beenSuccessfully Submitted will be displayed on the following page toconfirm the claim submission. The status of the claim will change to‘Pending Approval’.

Resubmit Claims in ‘System Rejected’ and ‘Service Coordinator Rejected’Status. A submitted claim containing the Billing Data users have enteredmay not be recorded as a Service Consumption for the reason that beforethe claim was generated by the system, the Service Authorization mayhave been updated and needs to be Acknowledged by the Linked Provider orbefore the claim was generated by the system, the Service Authorizationmay have been deleted by the Oversight agency. To check whether thereare any claims that are in ‘System Rejected’ status, users can go to theTo do tab of the Dashboard. If there are claims of this status, a‘System Rejected Worklist’ notification will appear under theProfessional Claim section of the To Do tab. To access these claims,users click on the number beside ‘System Rejected Worklist’ and selectthe claim to update on the following page (FIG. 29).

For claim forms in ‘System Rejected’ status, users will be able to editthe Billing Data to review any information contained within ifnecessary, such as Total Billable Units. Users then click on the linkbelow Billing Data ID under the ‘Service Lines’ section to open theBilling Data form. On the Billing Data form, users can make theappropriate changes and click on the ‘Update’ button. On the claim form,users click on the ‘Submit for Approval’ button at the bottom toresubmit for approval. A success message of The form has beenSuccessfully Submitted will be displayed on the following page toconfirm the claim submission. The status of the claim will change to‘Pending Approval’. Claims with status ‘Service Coordinator Rejected’are generated when Service Coordinators on the Oversight Agency rejectsthe submitted Service Consumption recorded by the Linked Provider. Theseclaims can be updated further to meet the requirements of the OversightAgency.

To check whether there are any claims that are in ‘Service CoordinatorRejected’ status, users can go to the To do tab of the Dashboard. Ifthere are claims of this status, a ‘Service Coordinator RejectedWorklist’ notification will appear under the Professional Claim sectionof the To Do tab. To access these claims, users click on the numberbeside ‘Service Coordinator Rejected Worklist’ and select the claim toupdate on the following page. For claim forms in ‘Service CoordinatorRejected’ status, users will be able to edit the Billing Data to reviewany information contained within, such as Total Billable Units. Usersthen click on the link below Billing Data ID under the ‘Service Lines’section to open the Billing Data form. On the Billing Data form, userscan make the appropriate changes and click on the ‘Update’ button. Onthe claim form, users click on the ‘Submit for Approval’ button at thebottom to resubmit for approval. A success message of The form has beenSuccessfully Submitted will be displayed on the following page toconfirm the claim submission. The status of the claim will change to‘Pending Approval’.

The medical claims are then routed to the appropriate servicecoordinator for approval.

If the claims are approved, they are sent to the designated servicecoordinator for approval. If disapproved, the claims are returned to theprovider with an explanation of the rejection. If approved, the claimsare sent to the state Medicaid and Medicare Information System (MMIS).

The state, individual, case manager and circle of support can have realtime access to the utilization data, based on caseloads and roles, tomonitor services and forecast future needs.

Oversight users may create a non-specialized provider for any unmappedService Provider. The ‘Service Provider’ information will automaticallypopulate on to the fields on the ‘NE Non Specialized Provider’ page.Users can select an unmapped service provider from the Service ProviderList page (FIG. 31). On the Service Provider page, users then click onthe ‘Create Non-Specialized Provider’ link under the ‘Service ProviderInformation’ section (FIG. 32). On the NE-Non Specialized Provider page,the fields, Provider Code, Provider Name and Login Name, are noteditable. Users may edit the rest of the fields and complete the set up.Users click on the Complete Setup button on the bottom of the form tocreate a non-specialized provider.

Download EOB Report: Electronic Remittance Advice (ERA), or Remittance835, is an electronic transaction which provides claim paymentinformation in the HIPAA mandated ACSX12 005010X221A1 format. Thesefiles are used by practices, facilities, and billing companies toautopost claim payments into their systems To download an Explanation ofBenefits (EOB), users can click on the Search option beside the 853Remittance Section from the Billing tab on the Dashboard (FIG. 30). Onthe Remittance 835 Search page, users can select an appropriate daterange and click on the Search button. On the next page, users click on afile name to open the file. Users will be taken to the Remittance 835Page. Users then click on the CSV Report/PDF Report/Text Report buttonto download the report. Users can also open the downloaded file to viewthe report in PDF, CSV or Text format (FIG. 33).

The present invention is not limited to the above-mentioned embodimentsand various modifications are considered without departing from thetechnical concept of the present invention.

What is claimed is: 1-37. (canceled)
 38. A HIPAA-compliant computersecurity method of sharing service, budget, and billing informationassociated with personal health information of one or more individualsamong at least a first organization and a second organization in anintegrated manner, and preventing unauthorized access to the billinginformation, the method comprising: a. receiving by one or more physicalnodes a first request for authorization for a user in the firstorganization to access service and budget information in the secondorganization pertaining to personal health information of one or moreindividuals, wherein the first organization is associated with a firstsecurity domain, the second organization is associated with a secondsecurity domain, the second organization has an access profileassociated with the first security domain, the user is associated withone or more roles and one or more caseloads, the service and budgetinformation for each of the one or more individuals having at least onetype, the one or more roles includes access privilege information forone or more users, and the one or more caseloads includes accessprivilege information for at least one individual or medical servicesprogram associated with said individual's personal health information,wherein the user is in the individual's circle of support and whereinsaid service and budget information includes a budget and service planfor the one or more individuals, wherein the service plan includes aplan for how to achieve the individual's goals and maintain theindividual's health and wellbeing; b. logging by the one or morephysical nodes, in an activity log associated with at least the firstorganization or the second organization, the user's first request forauthorization for the user in the first organization to access serviceand budget information in the second organization pertaining to the oneor more individuals; c. determining by the one or more physical nodeswhether the user in the first organization is authorized to accessservice and budget information in the second organization pertaining tothe one or more individuals, wherein the determination is based on atleast the access profile, the one or more caseloads and the one or moreroles associated with the user and the type of service and budgetinformation in the second organization pertaining to the one or moreindividuals and associated with said individual's personal healthinformation; d. responsive to determining that the user in the firstorganization is authorized to access service and budget information inthe second organization pertaining to the one or more individuals: i.transferring by the one or more physical nodes the service and budgetinformation in the second organization pertaining to the one or moreindividuals in compliance with HIPAA, and; ii. logging by the one ormore physical nodes, in the activity log, the transferring of serviceand budget information in the second organization pertaining to the oneor more individuals to the user in the first organization in compliancewith HIPAA; and  responsive to determining that the user in the firstorganization is not authorized to access service and budget informationin the second organization pertaining to the one or more individuals,preventing the requested access in compliance with HIPAA; and e.receiving, by one or more physical nodes, information pertaining toservices provided to the one or more individuals by the firstorganization and billing information generated by the first organizationpertaining to the provided services, wherein said information pertainingto services permits the user to monitor said service plan for achievingthe individual's goals and the individual's progress toward outcomes,and to forecast future needs.
 39. The method of claim 38, wherein thesecond organization provides a service authorization to the firstorganization prior to step (a).
 40. The method of claim 38, furthercomprising step (f) of generating claims for payment from theinformation pertaining to billing for services provided to the one ormore individuals.
 41. The method of claim 40, further comprising step(g) of submitting said claims for payment to at least one payor.
 42. Themethod of claim 38, wherein the user is a doctor, health careprofessional, case manager, or staff person of the first or secondorganization.
 43. The method of claim 38, wherein the first or secondorganization is a state.
 44. The method of claim 38, wherein the firstorganization is an independent provider.
 45. The method of claim 44,wherein the independent provider is a user providing non-specializedservices.
 46. A HIPAA-compliant computer security system for sharingservice, budget, and billing information associated with personal healthinformation of one or more individuals among at least a firstorganization and a second organization in an integrated manner, andpreventing unauthorized access to the billing information, the systemcomprising: a. means for receiving by one or more physical nodes a firstrequest for authorization for a user in the first organization to accessservice and budget information in the second organization pertaining topersonal health information of one or more individuals, wherein thefirst organization is associated with a first security domain, thesecond organization is associated with a second security domain, thesecond organization has an access profile associated with the firstsecurity domain, the user is associated with one or more roles and oneor more caseloads, the service and budget information for each of theone or more individuals having at least one type, the one or more rolesincludes access privilege information for one or more users, and the oneor more caseloads includes access privilege information for at least oneindividual or medical services program associated with said individual'spersonal health information, wherein the user is in the individual'scircle of support and wherein said service and budget informationincludes a budget and service plan for the one or more individuals,wherein the service plan includes a plan for how to achieve theindividual's goals and maintain the individual's health and wellbeing;b. means for logging by the one or more physical nodes, in an activitylog associated with at least the first organization or the secondorganization, the user's first request for authorization for the user inthe first organization to access service and budget information in thesecond organization pertaining to the one or more individuals; c. meansfor determining by the one or more physical nodes whether the user inthe first organization is authorized to access service and budgetinformation in the second organization pertaining to the one or moreindividuals, wherein the determination is based on at least the accessprofile, the one or more caseloads and the one or more roles associatedwith the user and the type of service and budget information in thesecond organization pertaining to the one or more individuals andassociated with said individual's personal health information; d. meansfor responding to a determination that the user in the firstorganization is authorized to access service and budget information inthe second organization pertaining to the one or more individuals saidmeans comprising: i. means for transferring by the one or more physicalnodes the service and budget information in the second organizationpertaining to the one or more individuals in compliance with HIPAA; andii. means for logging by the one or more physical nodes, in the activitylog, the transferring of service and budget information in the secondorganization pertaining to the one or more individuals to the user inthe first organization in compliance with HIPAA; and  means forresponding to a determination that the user in the first organization isnot authorized to access service and budget information in the secondorganization pertaining to the one or more individuals by preventing therequested access in compliance with HIPAA; and e. means for receiving,by one or more physical nodes, information pertaining to servicesprovided to the one or more individuals by the first organization andbilling information generated by the first organization pertaining tothe provided services, wherein said information pertaining to servicespermits the user to monitor said service plan for achieving theindividual's goals and the individual's progress toward outcomes, and toforecast future needs.
 47. The system of claim 46, further comprising ameans for providing a service authorization to the first organization.48. The system of claim 46, further comprising a means for generatingclaims for payment from the information pertaining to billing forservices provided to the one or more individuals.
 49. The system ofclaim 46, further comprising a means for submitting said claims forpayment to at least one payor.
 50. The system of claim 46, wherein theone or more physical nodes include one or more computers.
 51. The systemof claim 46, wherein the one or more physical nodes are at least twophysical nodes that are not identical and operate independently of eachother.
 52. The system of claim 46, wherein the one or more physicalnodes include one or more storage arrays.
 53. The system of claim 46,wherein the one or more physical nodes include one or more physical discdrives.